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References for Constipation Relief Page

These are the references for the web page " Fast Constipation-Pain Relief (1 Min Breathing Exercise)"

Henderson Y, Production of shock by loss of carbon dioxide, and relief by partial asphyxiation, Am J Physiol 1907, 19: p. XIV-XV.

Gilmour DG, Douglas IH, Aitkenhead AR, Hothersall AP, Horton PW, Ledingham IM, Colon blood flow in the dog: effects of changes in arterial carbon dioxide tension, Cardiovascular Research 1980 Jan; 14 (1): p. 11-20.

Gastroenterology. 1996 Aug;111(2):368-77.
Hyperventilation alters colonic motor and sensory function: effects and mechanisms in humans.
Bharucha AE, Camilleri M, Ford MJ, O'Connor MK, Hanson RB, Thomforde GM.
Gastroenterology Research Unit, Mayo Clinic, Rochester, Minnesota, USA.
BACKGROUND & AIMS. Hyperventilation-induced hypocapnia affects hemodynamic function and enhances colonic motility. The aims of this study were to determine the effects of hypocapnic hyperventilation on colonic motility and sensation in health and to explore the putative neurohumoral mechanisms.
METHODS: In experiment 1, colonic tone, sensation, plasma levels of cortisol, beta-endorphin, selected gut neuropeptides, norepinephrine, epinephrine, and splanchnic blood volume were measured during two sequences of hypocapnic hyperventilation. In experiment 2, colonic tone and sensation were assessed during eucapnic hyperventilation and abdominal compression.
RESULTS: Hypocapnic hyperventilation, but not eucapnic hyperventilation or abdominal compression, significantly increased colonic tone and sensitivity to balloon distention (P = 0.017) without altering humoral mediators or splanchnic blood volume. Plasma norepinephrine level increased (P = 0.017) and splanchnic blood volume decreased (P = 0.028) during 5 minutes after hyperventilation, consistent with homeostatic responses.
CONCLUSIONS: Increased colonic tone and sensation during hypocapnic hyperventilation are not caused by colonic compression. These effects of hyperventilation are not mediated humorally but may result from direct metabolic effects of hypocapnia on colonic muscle or from changes in central autonomic control of colonic smooth muscle.

Gut. 1995 Oct;37(4):499-504.
Hyperventilation, central autonomic control, and colonic tone in humans.
Ford MJ, Camilleri MJ, Hanson RB, Wiste JA, Joyner MJ.
Gastroenterology Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
Symptoms attributable to hyperventilation are common among patients with the irritable bowel syndrome (IBS); indeed, some have suggested that hyperventilation may exacerbate the alimentary symptoms of IBS. Hyperventilation changes hemodynamic function through central and peripheral mechanisms; its effects on colonic motor function, however, are unknown. The aim of this study, therefore, was to assess the effects of hyperventilation on colonic tone and motility and on cardiovascular autonomic activity, and to discover if hypocapnia was critical to elicit the response. Phasic and tonic motility of the transverse and sigmoid colon, end tidal PCO2, pulse rate, and beat to beat pulse variability were assessed before, during, and after a five minute period of hypocapnic hyperventilation in 15 healthy volunteers; in seven other subjects, effects of both eucapnic and hypocapnic hyperventilation were evaluated. Hypocapnic but not eucapnic hyperventilation produced an increase in colonic tone and phasic contractility in the transverse and sigmoid regions and an increase in pulse rate and pulse interval variability. The findings are consistent with inhibition of sympathetic innervation to the colon or direct effects of hypocapnia on colonic smooth muscle, or both. These physiological gut responses suggest that some of the changes in colonic function are caused by altered brain or autonomic control mechanisms.

Med Hypotheses. 1989 Feb;28(2):71-3.
Primary constipation: an underlying mechanism.
Sikirov BA.
Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. The only natural defecation posture for a human being is squatting. The alignment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. There is no evidence that habitual bowel elimination at a given time each day contributes considerably to the final act of rectal emptying. The natural behavior to empty the bowels in response to a strong defecation reflex alleviates bowel emptying by means of the recto anal inhibitory reflex.

Dig Dis Sci. 2003 Jul;48(7):1201-5.
Comparison of straining during defecation in three positions: results and implications for human health.
Sikirov D.
The aim of the study was to compare the straining forces applied when sitting or squatting during defecation. Twenty-eight apparently healthy volunteers (ages 17-66 years) with normal bowel function were asked to use a digital timer to record the net time needed for sensation of satisfactory emptying while defecating in three alternative positions: sitting on a standard-sized toilet seat (41-42 cm high), sitting on a lower toilet seat (31-32 cm high), and squatting. They were also asked to note their subjective impression of the intensity of the defecation effort. Six consecutive bowel movements were recorded in each position. Both the time needed for sensation of satisfactory bowel emptying and the degree of subjectively assessed straining in the squatting position were reduced sharply in all volunteers compared with both sitting positions (P < 0.0001). In conclusion, the present study confirmed that sensation of satisfactory bowel emptying in sitting defecation posture necessitates excessive expulsive effort compared to the squatting posture.

Med Hypotheses. 1990 Jul; 32(3): 231-3.
Cardio-vascular events at defecation: are they unavoidable?
Sikirov BA.
Cardio-vascular events at defecation are to a considerable degree the consequence of an unnatural (for a human being) seating defecation posture on a common toilet bowl or bed pan. The excessive straining expressed in intensively repeated Valsalva Maneuvers is needed for emptying the bowels in sitting position. The Valsalva Maneuver adversely affecting the cardio-vascular system is the causative factor of defecation syncope and death. The cardio-vascular system of a healthy man withstands the intensive and repeated straining at defecation, while the compromised cardio-vascular system may fail resulting in syncope or even death. The squatting defecation posture is associated with reduced amounts of straining and may prevent many of these tragic cases.

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